CASTLEMAN DISEASE: A GREAT MIMICKER OF METASTASES IN RADIOIODINE REFRACTORY THYROID CANCER

A 27-year-old male underwent total thyroidectomy for thyroid swelling. Histopathology showed papillary thyroid carcinoma [T3 - 6.0 cm] with extra-thyroidal extension. The patient was treated with 150 mCi radioactive iodine(RAI) as adjuvant ablative therapy. Radioiodine refractory disease was identified 1-year post-RAI therapy with elevated thyroglobulin levels and negative I-131 whole body scan. F-18 FDG positron emission tomography/computedtomography scan showed activity in the right thyroid bed and multilevel right cervical nodes. Right-sided modified neck dissection was done, which showed Castleman disease (hyaline vascular type) in right cervical nodes. The most probable cause of elevated tumour markers was found out to be 0.6 cm right thyroid bed nodule on follow-up ultrasonography. Our patient also had coexistent conditions as; osteopoikilosis and Hepatitis C along with thyroid carcinoma.Key words: Castleman disease, lymph node, radioiodine, thyroid cance

How Audit Quality Affects Cash Holdings: Evidence from China

This is one the maiden studies that aim to reveal the association between audit quality and cash holdings among non-financial firms in the unique context of China, that is a major developing economy. Although previous studies have looked at the wider impact of governance systems on cash holdings decisions, there isn't much research on the precise connection between audit quality and company cash holdings—particularly in China's developing economies. This study, which has bases in agency, auditing, and cash theories, makes an assertion that stronger audit quality has tendency to discourage managers from hoarding extra cash holdings, thereby highlighting the significance of audit quality to be an instrument for monitoring. This study employs ordinary least squares (OLS) regression and fixed effects (FE) models to examine the effects of audit quality variables on cash holdings. This study uses the generalized method of moments (GMM) model for robustness. It employs a large sample dataset comprising 20203 observations of Chinese non-financial enterprises for the period of 2003-2016. This study confirms that audit quality works as a monitoring device and discourages unnecessary accumulation of Chinese firms' cash holdings. Audit quality dimensions, the Big4 auditors, audit fees, and the fear of receiving an unclean audit opinion work as regulating forces that stop managers' unnecessary holdings of cash reserves. This study contributes to governance systems and cash holdings in China. It is a maiden one to comprehensively employ audit quality as a corporate governance mechanism to assess how it affects cash holdings

Developers' Privacy Education: A game framework to stimulate secure coding behaviour

Software privacy provides the ability to limit data access to unauthorized parties. Privacy is achieved through different means, such as implementing GDPR into software applications. However, previous research revealed that the lack of poor coding behaviour leads to privacy breaches such as personal data breaching. Therefore, this research proposes a novel game framework as a training intervention enabling developers to implement privacy-preserving software systems. The proposed framework was empirically investigated through a survey study (with some exit questions), which revealed the elements that should be addressed in the game design framework. The developed game framework enhances developers' secure coding behaviour to improve the privacy of the software they develop.Comment: 1

NMDA encephalitis in an elderly with poor prognosis

We present a case of a 65 years old man from Islamabad who presented with six months history of psychiatric and behavioural symptoms, significant weight loss. Later on he developed difficulty swallowing and altered sensorium. This was followed by an episode of shortness of breath leading to respiratory arrest, followed by ICU stay on ventilator support, then developed focal deficit in form of left sided weakness, dysautonomia, bradycardia leading to cardiac arrest and another cardiopulmonary resuscitation, myoclonic jerks, orofacial dyskinesias, status epilepticus, coma ultimately resulting in death of the patient. Patient was found to be NMDA receptor antibody positive. CT chest and abdomen did not reveal any hidden malignancy. Patient was given intravenous pulse steroids for 5 days followed by five sessions of plasmapheresis but did not respond. He stayed on ventilator support for 40 days and did not improve. This is the second case of antibody proven NMDA encephalitis from Pakistan, the first being from Islamabad as well and published in this journal

Comparison of Slow versus Rapid Feeding Regimen in Preterm Neonates in the reduction of hospital stay

Introduction: In preterm babies delay in the achievement of full feeds causes prolonged hospital stay. This study will help in the nutritional management of preterm babies which will shorten the hospital stay and reduce the economic burdens on parents. Objective: To compare the mean duration of hospital stay of preterm neonates with two different feeding protocols(slow feeding regimen versus rapid feeding regimen). Materials and Methods: This study was conducted in the neonatal unit at Izzat Ali Shah Hospital from October 2019 to March 2020 through a randomized controlled trial. A total of 102 (51 in each group) were randomized to slow feeding (Group A) and Rapid feeding(Group B). Depending on the birth weight and gestational age, a certain amount of breast milk was initiated, with increments of 15-20 mL/kg/day in the slow feeding group & 25-30 ml/kg/day in the rapid feeding group. Feeding was stopped temporarily in case of any sign of feeding intolerance, suspected necrotizing enterocolitis, recurrent apnoeic episodes, and neonatal seizures. The total target feed was 180 ml/kg per day. Infants were continued in the study until discharged from the hospital.   Results: Our study shows that the mean gestational agein Group A (Slow feeding) was 34 weeks with SD ± 2.68 while the mean gestational agein Group B (Rapid feeding) was 35 weeks with SD ± 1.98. In Group A (Slow feeding) 55% neonates were male while 45% neonates were female. Whereas in Group B (Rapid feeding) 57% neonates were male while 43% neonates were female. In Group A (Slow feeding) mean hospital stay was 22 days with SD ± 7.02. In Group B (Rapid feeding) mean hospital stay was 13 days with SD ± 3.72.  Conclusion: Our study concludes that mean hospital stay in the rapid advancement of feeds was shorter as compared to the slow feeding of preterm neonates

Intra-abdominal Hypertension and Abdominal Compartment Syndrome in patients undergoing emergency laparotomy

Objective: The objectives of the Prospective observational study were to identify the frequency of abdominal compartment syndrome and intraabdominal hypertension in patients undergoing emergency laparotomy for trauma and peritonitis and to determine the impact of raised intraabdominal pressure on the overall morbidity and mortality. Materials and Methods: The study was conducted in the department of surgery Benazir Bhutto Hospital Rawalpindi. From June 2013 to May 2014 a total of 50 patients undergoing emergency laparotomy were included. IAP was measured preoperatively then postoperatively at 0, 6, 24 hours, and the findings were recorded on a specially designed preform. The patients having higher IAP were further evaluated up to 72 hours. All vitals, urine output, oxygen saturation, serum urea, creatinine were noted. The main outcomes were duration of hospital stay, the occurrence of burst abdomen, and mortality. Results: At the preoperative level the incidence of IAH was 86%. The mortality association with IAH at 6 hours postoperatively was quite significant (P<0.029). The incidence of postoperative ACS was 5% among the total patients and it was 15.6% in trauma patients. No significant association was found between IAP and occurrence of burst abdomen at any level (P values 0.4, 0.26, 0.53, 0.58 at intervals preoperatively, 0, 6, 24 hours postoperative respectively.  Conclusion: Intraabdominal pressure is an important factor that predicts the mortality of patients undergoing emergency laparotomy. It should be carefully monitored and managed accordingly to avoid the detrimental effects on virtually all organ systems. Abdominal decompression in significantly elevated intraabdominal pressure reverts the physiological derangement of Intrabdominal hypertension

A Novel Water Quality Index for Iraqi Surface Water

هدفت هذه الدراسة الى بناء موديل لنوعية المياه يكون مناسب للنظم المائية العراقي ويعكس الواقع البيئي للمياه العراقية. دليل نوعية المياه العراقية المطور يتضمن عوامل فيزيائية وكيميائية. من اجل بناء دليل نوعية المياه العراقي IQWQI  تم استخدام طريقة دلفي للتواصل مع الخبراء المحلين والعالميين المختصين بنوعية المياه لغرض الحصول على اراءهم بخصوص اهم العوامل المهمة التي يمكن استخدامها لبناء الدليل وحسب طبيعية النظام البيئي العراقي وتحديد وزن لكل عامل. 70% من البيانات التي تم الحصول عليها من هذه الدراسة قد استخدمت لبناء الدليل و 30% استخدمت لاختبار الدليل. تم تطبيق عدة سيناريوهات لمدخلات الموديل لغرض دراسة تأثير زيادة العوامل. تم بناء الموديل من 4 عوامل لأربع مرات جمع عينات حتى وصل الى 17 عامل لعشرة مرات جمع عينات. ومن الواضح انه عند زيادة عدد العوامل فان قيمة الدليل سوف تتغير. لغرض تقليل التأثير المخفي للعوامل التي تتجاوز المحددات المسموحة والذي يظهر عند استخدام WQI  ولحل هذا التداخل بين النوعية والتلوث فقد اوجدت هذه الدراسة دليل اخر يكون مرتبط بـ IQWQI والذي يضم كلا من درجة النوعية والتلوث. سمي الدليل الثاني دليل المخاطر البيئية ERI ويضم فقط العوامل التي تجاوزت الحدود البيئية المسموح بها. أجري تحليل الحساسية لغرض التنبؤ بقيم IQWQI وتحديد اهم العوامل المؤثرة في قيم IQWQI، تم اختيار موديلين  لأجراء تحليل الحساسية وهما انحدار الشبكة العصبية الاصطناعية والمعتمد على التعلم الالي ((ANNRThe study aims to build a water quality index that fits the Iraqi aquatic systems and reflects the environmental reality of Iraqi water. The developed Iraqi Water Quality Index (IQWQI) includes physical and chemical components. To build the IQWQI, Delphi method was used to communicate with local and global experts in water quality indices for their opinion regarding the best and most important parameter we can use in building the index and the established weight of each parameter. From the data obtained in this study, 70% were used for building the model and 30% for evaluating the model. Multiple scenarios were applied to the model inputs to study the effects of increasing parameters. The model was built 4 by 4 until it reached 17 parameters for 10 sampling times. Obviously, with the increasing number of parameters, the value of the index will change. To minimize the effect of eclipse that arises in WQI and to solve the problem of overlapping quality and pollution, this study has created another index linked with IQWQI, which included both the quality and the degree of pollution. The second index is called the Environmental Risk Index (ERI), where only the variables that exceed the permissible environmental limits were included. Sensitivity Analysis was done to predicate IQWQI and to determine the most influential parameters in the IQWQI score; two types of models were chosen for the run of the sensitivity test, which are the Artificial Neural Network Regression (ANNR) and Backward Linear Regression (BLR). The results of IWOI and ERI for freshwater use during the dry season were very poor water quality with a high degree of risk. While in the wet season, both indices' values ranged from poor water quality to very poor water quality with a high degree of risk

Expressive Appropriateness in contemporary architectural production

The concept of Appropriateness has emerged by thousands of years, since the architect Vitruvius, as one of the most important theoretical aspects that achieve integrated architecture. It has evolved over the years in the postmodern architecture to the importance of the recipient and his reading of the architectural text. The concept varied and numerous such as ( functional, structural, expressive , environmental, social, and economic) Appropriateness . The research emerged many of the architectural and non architectural studies related to the concept of Appropriateness, where achieved to the importance of the expressive side and expressive Appropriateness. The research identified problem as "Lack of a comprehensive & objective perception about the expressive Appropriateness in contemporary architectural production and the relationship between the designer intentions and the mechanisms of expressive Appropriateness on one hand and what actually achieved in production on the other ". The goal of this research is to "form an objective and comprehensive framework for expressive appropriateness properties in the contemporary architectural production and explore the relationship between the designer intentions and the mechanisms on one hand and what actually done in the production according to the opinion of the recipient" . The research built a framework contained a primary and secondary items , then elected goals and mechanisms of expressive Appropriateness and applied them on an elected group of contemporary architectural projects after an analytical study of these projects. The conclusions concerning the multiple mechanisms achieved and concatenated as they arise (encoding and metaphor and similarity), and the variation of expressive Appropriateness achievement is due to the diversity of goals and mechanisms adopted. Key words: Expressive Appropriateness, contemporary architectural productio

The level of serum Tumor Marker CA15-3 in women with Breast Cancer

Background: Breast cancer is the most frequently diagnosed type of cancer in women in all world regions. About 1.7 million cases of breast cancer are diagnosed every year. Breast cancer is the most common cause of death in women worldwide. There were approximately 0.5 million deaths worldwide from breast cancer in 2012, several serum tumor markers have been evaluated in breast cancer. CA15-3 is the most important serum biomarkers used for diagnosis and monitoring of breast cancer. Objective: To evaluate the level of CA15-3 of studied groups according to age categories, residence nearby industries, and history of breast feeding. Patients and Methods: This study was carried out at the Breast Surgery Outpatients and the Oncology Clinic at Oncology Teaching Hospital in Baghdad. It included 50 women who were newly diagnosed by oncology group to have had breast cancer and didn’t receive chemotherapy yet and 50 healthy women as control. Results: There was significant increase at (P> 0.05) in serum CA15-3 level of patients with age category (71-80) years (198.33 ± 136.60 U/ml) and significant elevation in serum CA15-3 level of patients who lived near industries or incinerators (120 ± 94.52 U/ml) also there was significant increase in serum CA15-3 level in healthy women with breast feeding history (25.8 ± 15.26 U/ml). Conclusion: CA15-3 level significantly elevated in elderly patients with age category (71-80) years and in patients with residence nearby industries or incinerators. Therefore, those patients at high risk of developing metastatic breast cancer or advanced stages of breast cancer